Spontaneous Retroperitoneal Hemorrhage withPsoasHematoma i n anElderlyPatient: ADiagnostic and Therapeutic Challenge

Spontaneous retroperitoneal hemorrhage (SRH) is a rare and potentially life-threatening condition, often challenging to diagnose and manage, especially in elderly patients with multiple comorbidities. Psoas hematoma is a known complication that can be associated with anticoagulation therapy. A 93-year-old male patient with a history of atrial fibrillation, chronic heartfailure, and anticoagulant use (apixaban) presented with complaints of dizziness following a fall in the bathroom. He was initially assessed in the neurology clinic for potential cognitive symptoms; however, while awaiting assessment, he experienced a syncopal episode, resulting in his transfer to the emergency room. The patient had a significant reduction in hemoglobin levels, necessitating additional examination. Imaging revealed an 8 cm left psoas hematoma with active extravasation. The patient received a blood transfusion, vitamin K, and therapeutic interventions, including interventional radiology, which effectively halted the hemorrhage. This case highlights the diagnostic complexity and therapeutic challenges posed by spontaneous retroperitoneal hemorrhage in elderly patients, especially those on anticoagulant therapy. Early recognition and appropriate intervention are crucial for patient recovery.